Every patient has a number nobody warned them about — a denial letter, a copay, a bill that shouldn't exist.
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Hosted by Terry Wilcox, co-founder and CEO of Patients Rising.
There's a federal program that lets many of the country's largest nonprofit hospitals buy outpatient drugs at deep discounts — 25%, 50%, sometimes 70% off. Last year it moved more than $81 billion.
So where did the money go?
The program is called 340B, and the entire justification for it is that the savings reach vulnerable and underserved patients. But hospitals aren't required to show where those savings land, and no patient is ever told the discount touched their prescription. There's no box on your receipt that says "I'm a 340B patient." A medication can save your hospital $5,000 and you'll pay the same copay and walk out knowing nothing.
So Patients Rising stopped arguing about surveys and went to the one place the relationship between a hospital and a struggling patient becomes a public record: bankruptcy court. Federal law requires filers to list every creditor and every dollar owed, under penalty of perjury. We read 903 consumer bankruptcy filings across six states. In 406 of them — 45% — the household owed money to a hospital we could verify takes the 340B discount. $6,622,650, sworn to by families listing everything they owed in the world.
To be fair: this is not a call to cut 340B, cap it, or dismantle it. In many places it does exactly what it was built to do. And we are not claiming 340B caused a single one of these bankruptcies. We're saying the same nonprofit systems keep appearing as creditors of the exact patients the program exists to serve — and no one can see whether the discount ever reached them.
In this episode: what 340B is and why Congress created it in 1992. A Louisiana household with $1,800 a month in income and $386,758 owed to a single hospital. Why a bad-debt write-off at the end of a bankruptcy can be counted as "community benefit" on a hospital's federal tax form. A woman in Chicago who filed over an $18,000 bill and was never told she qualified for financial assistance. And three reforms that would finally let the public see the program: define who a "340B patient" actually is, separate charity care delivered from bad debt written off, and tell patients at the pharmacy counter — before the bill, not after the bankruptcy.
Good programs survive scrutiny. This isn't a call to cut 340B. It's a call to be able to see it.
Blog: Read the recap
White paper: Medical Bankruptcy in America — 340B Hospitals as Creditors in Consumer Bankruptcy [WHITE PAPER LINK]
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